Profile of Inner City HIV Clients

1
Profile of Inner City HIV Clients

• Presidential Advisory Council on
  HIV/AIDS
• Washington, DC
• March 17, 2006
• Dr. Wilbert C. Jordan,
  Director
• OASIS Clinic and HIV/AIDS Program
• King-Drew Medical Center
  
• Los Angeles, CA

2
Table 1FAMILIARITY WITH SEX PARTNERS OF HIV
POSITIVE PATIENTS WHO WERE INFECTED BY SEXUAL
CONTACT

• PATIENTS INTERVIEWED DURING ONE MONTH PERIOD
• Men Women
• TOTAL NUMBER 52 22
• Number who knew all sex partners 6 22
• Number who knew all partners and how 5 19
• to contact
• Percentages 6/5212 22/22100
• 5/5210 19/2286

3
Table 3OASIS CLINIC PATIENTSKING-DREW MEDICAL
CENTERJUNE 1996

• FOCUSED INTERVENTION I
• Two groups of patients 14 per group
• initially questioned
• Group A Number who felt they knew 13
• people still practicing at risk sex
• Group B Number who felt they had friends 14
• and acquaintances who were HIV

4
Table 4GROUP APROFILE OF 13 PATIETNS WHO KNEW
PERSONS STILL PRACTING AT RISK SEX

• Number of persons identified 30
• Number of these found to be HIV 17
• Number of the 17 who were unaware 9
• of their status
• Yield (9/30) 30

5
Table 5DATA FROM 14 OASIS CLINIC PATIENTS WHO
FELT THEY KNEW PEOPLE WHO WERE HIV

• Number identified 15
• Number who were HIV 11
• Number who were aware and in treatment 0/11
• Number who were aware and not in treatment 3
• Number unaware of status 8
  

6
The High Rollers

• Client Areferred 38 people32 tested HIV two
  were tested previouslyone was aware but not in
  treatment and one tested HIV while in prison.
• Client A is a Transgender who has been
  incarcerated 4 times during the past 5 years,
  accounting for 2 years and 8 months.
• Client Breferred 14 people13 tested HIVnone
  were previously testedClient B is presently
  incarcerated for the 4th time over the past 3
  yearsall have a recent history of incarceration.

7
Los Angeles County Test Rates

• Anonymous Test Sites 1.5
• Confidential Testing Centers 1.4

8
Table 2FOCUSED INTERVENTION

• Our program lead to the GSK ACT4 Life Program
• What we do
• Our caregivers identify patients to recruit
  (serve as a recruiter) their friends
• Incentives are given to the client and their
  recruiter

9
Table 6What it allows us to know, since 93 of
those testing HIV- admit to unprotected sex
within past two years Who are the High Risk
Negatives?

• Women
• 1. Young girls dating older men
• 2. Older women whose partners have been
  incarcerated
• 3. Strawberries/sex for drugs
• 4. Church girls
• Men
• 1. Open /-
• a. Pride Inc.
• 1. Pride week in Washington, DC (memorial
  day weekend)
• 2. ATB in Los Angeles (July 4th weekend)
• 3. Atlanta, GA (Labor Day)
• b. Gospel Groups
• 2. Closeted men
• 3. The incarcerated
• 4. Transgenders

10
Profile of HIV Men

• OASIS Clinic data
• 1998-2002
• Number interviewed 374
• Number infected MSM 353
• Number prefer gay to homosexual 104
• Number identify as homosexual. 44
• Number identify as bi-sexual .123
• Number dont identify as neither.82

11
Prefer Gay to Homosexual 104

• Total number
  104
• Comfortable identifying as Gay
• everywhere and to everyone33
• Mom doesnt know 27
• Some friends know/some dont 38
• Not ashamed, no reason to advertise 17
• Comfortable in any Gay setting 47

12
Prefer Gay to Homosexual

• Total number 104
  w/ women
• Prefer to Top only 2
  0
• Prefer Top gt Btm 5
  1
• Prefer Btm gt Top 48
  3
• Prefer Btm only 49
  3

13
Identify as homosexual - 44

• Prefer to Top only 7
• A. With younger men 6
• Prefer Top gt Btm 6
• Prefer Btm gt Top 15
• Prefer Btm only 16

14
Identify as Bisexual 123

• 
  active w/ women
• Prefer to Top only 2
  1
• Prefer Top gt Btm 9
  4
• Prefer Btm gt Top 62
  11
• Prefer Btm only 50
  17

15
Dont accept either term 82

• Initial MSM contact in jail
  43
• Initial MSM contact w/friend
  24
• Initial MSM contact in Military
  14
• Initial MSM contact for money 22

16
Dont accept either term

• 
  active w women
• Prefer Top only 7
  5
• Prefer Top gt Btm 14
  4
• Prefer Btm gt Top 22
  11
• Prefer Btm only 16
  8
• Prefer oral by men 23
  15
• admit to being anal receptive only once or
  twice

17
Interview with 582 Black MSMOASIS Clinic
King-Drew Medical CenterLos Angeles,
California1997-2000

• Percent raped in childhood 62
• Percent probably infected more than 5 years 68
• Of those infected more than 5 years, the
  percent 17
• with children under 5 years of age
• Those with a regular partner 4
• Those who engage in at risk sex 52
• Number of drinks needed to allow them to
  engage 2.1
• in at risk sex
• Number of drinks usually consumed when going
  out 4.8

18
Men raped in Childhood - 361

• Number who considered the rapist to be
  homosexual.38
• Initial act included sodomy..357
• Initial act occurred more than once..223

19
Initial act repetitive 223

• Mamas boyfriend85
• Older half brother/cousin.43
• Step-brother..11
• Uncle..16
• Family friend..37
• Teacher/coach..21
• Policeman3
• Other 7

20
Initial contact one time only 138

• Mamas boyfriend..28
• Step-father6
• Step-brother.9
• Older brother /cousin...19
• Younger uncle12
• Family friend23
• Someone 2-3 yrs older24
• Someone 1-3 yrs younger7
• Policeman.1
• Teacher/coach.4
• Choir director/ church related..7
• Grandfather.5

21
Male to female Transgender patients- 32

• 1. HIV ..32
• 2. Living married/monogamous.4
• 3. Prefer to be Btm exclusively.32
• 4. Penetrated a man in past 2 yrs..11
• 5. Penetrated a woman in past 2 yrs1
• 6. Taking oral hormones..32
• 7. Taking lupron infections...23

22
Transgender patients - 32

• 1. Hx of incarceration ....31
• 2. Hx of STD.23
• 3. Started under age 12 .1
• 4. Started between 12-193
• 5. Started over age 20 ..28

23
(No Transcript)
24
The incidence of HIV/AIDS within diverse
communities is a national crisis. We will not
rest until the crisis is acknowledged and
strategies and resources are directed to
eliminate it. Representative Maxine Waters
Then Chair of the Congressional Black Caucus
March 15, 1999
25
(No Transcript)
26
45 of Eligible US Patients Not On HAART
Teshale E, et al. Abstract 167.
27
HIV/AIDS UNREACHED POPULATION

• Status of People Black
• Overall
• Undiagnosed 266,000 55
• Aware, not in health care 169,000 37
• African Americans
• Undiagnosed 146,000 100
• Aware, not in health care 63,000 100

28
Outreach

• Can we identify this large number of HIV
  African American men and women? I think so !!
• Resolve that the National Medical
  Association, the national organization of Black
  physicians with over 7000 members, have as its
  project
• 1. To have all Black physicians, and all
  physicians who treat Black patients, to test
  all of them twice annually, May 15 June 19
  in honor of Juneteenth, and November 1- 30,
  leading up to World AIDS Day.

29
NMA Project

• 1. Corldination of outreach activities with
  CBOs and the Churches
• 2. Goal To identify 10,000 new HIV cases
  bi-annually
• 3. Through the NMA, identify new physicians,
  primarily minority, to treat this new influx
  of HIV clients
• 4. Advocate on behalf of the providers and
  clients for funding

30

• Q A